Diagnosing & Caring for Patients with Fibromyalgia

Noting that a diagnosis of fibromyalgia is often missed in men, Doebl et al. say their study data indicate an urgent need exists for a model of care for patients with fibromyalgia. Stefanie Doebl, a graduate student at the University of Aberdeen, U.K., and colleagues call for an approach that ensures prompt diagnosis, access to evidence-based care and long-term support for patients. They published their results in the June 2021 issue of Arthritis Care & Research.¹

Study Design

The investigators began their study by contacting people who had responded to the maintaining musculoskeletal health (MamMOTH) screening survey. In the MamMOTH clinical trial, researchers recruited patients without chronic, widespread pain who were at risk of developing chronic widespread pain, defined as having regional pain, sleep disturbances, multiple somatic symptoms and/or certain illness behaviors.² Individuals were invited to take part in the current study if they had responded to the MamMOTH screening questionnaire and indicated a willingness for future contact. Not all individuals included in the study had fibromyalgia symptoms and not all the individuals who had fibromyalgia symptoms had been diagnosed with fibromyalgia.

In 2010, the ACR released new preliminary criteria for fibromyalgia.³ The criteria removed tender points as the central element of the fibromyalgia definition, identified the importance of the widespread pain index, incorporated key fibromyalgia symptoms into the criteria and provided severity scales to measure the extent of widespread pain and symptom severity. The new criteria made it possible to evaluate fibromyalgia as a continuum of symptoms. Doebl et al. used the widespread pain index and symptom severity scale and determined that patients met the criteria of fibromyalgia if the sum of their scores on these two fibromyalgia measures was at least 12 out of 31.³

The investigators sent out a questionnaire and analyzed the responses from 85 individuals with a fibromyalgia diagnosis, 110 individuals who met the criteria for fibromyalgia but had not been diagnosed, and 133 individuals with chronic pain.

The Results

The team compared the effect of symptoms and the healthcare use of people diagnosed with fibromyalgia with those who fulfilled the criteria for fibromyalgia but had not been diagnosed, as well as with those with chronic pain. The mean age across groups was similar, at 57–59 years, but the percentage of women in the groups differed markedly: 86% of those diagnosed with fibromyalgia were women; 64% who met the criteria for fibromyalgia but had not been diagnosed were women; and 67% of those with chronic pain and no diagnosis of fibromyalgia were women. These results suggest that although women and men are almost equally likely to meet the criteria for fibromyalgia, women are more likely to be diagnosed with fibromyalgia. Moreover, that diagnosis took a long time, with patients reporting that it took an average of three years from the onset of symptoms before they received a fibromyalgia diagnosis.